Provider Demographics
NPI:1265424691
Name:ABRAHAM, ANNIE (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8150
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-8150
Mailing Address - Country:US
Mailing Address - Phone:866-325-0301
Mailing Address - Fax:
Practice Address - Street 1:2021 N TOWN EAST BLVD STE 500
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4079
Practice Address - Country:US
Practice Address - Phone:866-325-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX650512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097798502Medicaid
TX097798502Medicaid
8K5698Medicare UPIN